DSM-IV-TR and DSM-5 eating disorders in adolescents: prevalence, stability, and psychosocial correlates in a population-based sample of male and female adolescents

Abstract

The current study aimed to compare the prevalence, stability, and psychosocial correlates of DSM-IV-TR and DSM-5 eating disorders, in a population-based sample of male and female adolescents followed prospectively from 14 to 20 years of age. Participants (N = 1,383; 49% male) were drawn from the Western Australian Pregnancy Cohort (Raine) Study, a prospective, population-based cohort study that has followed participants from prebirth to young adulthood. Detailed self-report questionnaires were used to assess eating disorder symptoms when participants were aged 14, 17, and 20 years. Comparisons between DSM-IV-TR and DSM-5 were conducted using McNemar chi-square tests and Fisher's exact tests. Changes in eating disorder prevalence over time were considered using generalized estimating equations. Eating disorder prevalence rates were significantly greater when using DSM-5 than DSM-IV-TR criteria, at all time points for females and at age 17 only for males. "Unspecified"/"other" eating disorder diagnoses were significantly less common when applying DSM-5 than DSM-IV-TR criteria, but still formed 15% to 30% of the DSM-5 cases. Diagnostic stability was low for all disorders, and DSM-5 binge eating disorder or purging disorder in early adolescence predicted DSM-5 bulimia nervosa in later adolescence. Cross-over from binge eating disorder to bulimia nervosa was particularly high. Regardless of the diagnostic classification system used, all eating disorder diagnoses were associated with depressive symptoms and poor mental health quality of life. These results provide further support for the clinical utility of DSM-5 eating disorder criteria, and for the significance of binge eating disorder and purging disorder.